title: Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia.
abstract: OBJECTIVE
  To provide updated evidence of the outcome of breast lesions of uncertain malignant potential (B3) and suspicious of malignancy (B4) diagnosed on needle core biopsy (NCB) and analyse the outcome of the different types of intraductal epithelial atypia.
  
  
  RESULTS
  One-hundred and forty-nine B3 and 26 B4 NCBs diagnosed over a 2-year period (2007-2008) were compared with those diagnosed over a previous 2-year period (1998-2000). The proportion of B3 diagnoses increased from 3.1% to 4.5%, and the positive predictive value (PPV) of malignancy of a B3 core decreased from 25% to 10%. Increased diagnosis of radial scar and reductions in the PPV of lobular neoplasia and of atypical intraductal proliferation may explain the reduction in the PPV of the B3 group as a whole. There were no significant changes in the proportion of B4 diagnosis (1.1% and 0.8%) or the PPV of B4 (83% and 88%). Review of cores with intraductal atypia showed a wide range of PPVs, from 100% for suspicious of ductal carcinoma in situ, to 40% for atypical ductal hyperplasia categorized as B3, and 14% for isolated flat epithelial atypia.
  
  
  CONCLUSIONS
  The study has found a decrease in the PPV for a B3 diagnosis and suggests possible explanations.
authors.affiliation: Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK.
authors.forename: Emad A
authors.initials: EA
authors.lastname: Rakha
authors.forename: Bernard C
authors.initials: BC
authors.lastname: Ho
authors.forename: Veena
authors.initials: V
authors.lastname: Naik
authors.forename: Soumadri
authors.initials: S
authors.lastname: Sen
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Hamilton
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Hodi
authors.forename: Ian O
authors.initials: IO
authors.lastname: Ellis
authors.forename: Andrew H S
authors.initials: AH
authors.lastname: Lee
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D008327:Mammography; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests